Kathleen M Malee1, Stephen Kerr2, Robert Paul3, Thanyawee Puthanakit2,4, Kulvadee Thongpibul5, Pope Kosalaraksa6, Pradthana Ounchanum7, Suparat Kanjanavanit8, Linda Aurpibul9, Chaiwat Ngampiyaskul10, Wicharn Luesomboon11, Jurai Wongsawat12, Saphonn Vonthanak13, Penh S Ly14, Kea Chettra14, Tulathip Suwanlerk2,15, Jiratchaya Sophonphan2, Victor Valcour16, Jintanat Ananworanich17,18,19,20, Claude A Mellins21. 1. Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 2. HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand. 3. Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, Missouri, USA. 4. Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok. 5. Department of Psychology, Faculty of Humanities, Chiang Mai University, Chiang Mai. 6. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen. 7. Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai. 8. Nakornping Hospital. 9. Research Institute for Health Sciences, Chiang Mai. 10. Prapokklao Hospital, Chanthaburi. 11. Queen Savang Vadhana Memorial Hospital, Chonburi. 12. Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand. 13. University of Health Science. 14. National Center for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia. 15. TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand. 16. Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA. 17. SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand. 18. The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda. 19. U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA. 20. Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands. 21. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, USA.
Abstract
OBJECTIVES: Psychosocial challenges associated with perinatally acquired HIV (PHIV) infection are well known, yet many children infected with HIV since birth demonstrate positive outcomes, referred to as resilience. The purpose of this study was to evaluate emotional-behavioral development and identify salient predictors of resilience among long-term survivors of PHIV. DESIGN: Prospective investigation of children with PHIV compared with demographically similar perinatally HIV-exposed but uninfected (PHEU) and HIV-unexposed, uninfected (HUU) children, all from Thailand and Cambodia. METHODS: The Child Behavior Checklist (CBCL; parent version) was administered at baseline and annual follow-up visits (median follow-up of 3 years) to children age 6-14. Resilience was defined as consistent CBCL scores on the Internalizing, Externalizing or Total Problem T scales within normative ranges (T-scores <60) at every time point. Generalized estimating equations examined CBCL scores over time and logistic models examined demographic, socioeconomic, and cultural predictors of resilience. RESULTS:Participants included 448 children (236 PHIV, 98 PHEU, 114 HUU), with median (interquartile range) age at first evaluation of 7 (6-9) years. Children with PHIV exhibited similar rates of resilience as PHEU and HUU on the Externalizing and Total Problems scales. Resilience on the Internalizing scale was more likely in PHEU (71%) compared with PHIV (59%) or HUU (56%), P = 0.049. Factors associated with resilience in adjusted models included: HIV-exposed but uninfected status, higher household income, Cambodian nationality, female sex, and caregiver type. CONCLUSION: Despite biopsychosocial risks, resilience is observed among PHIV and PHEU children. Further study is needed to understand mechanisms underlying associated factors and intervention priorities.
RCT Entities:
OBJECTIVES: Psychosocial challenges associated with perinatally acquired HIV (PHIV) infection are well known, yet many childreninfected with HIV since birth demonstrate positive outcomes, referred to as resilience. The purpose of this study was to evaluate emotional-behavioral development and identify salient predictors of resilience among long-term survivors of PHIV. DESIGN: Prospective investigation of children with PHIV compared with demographically similar perinatally HIV-exposed but uninfected (PHEU) and HIV-unexposed, uninfected (HUU) children, all from Thailand and Cambodia. METHODS: The Child Behavior Checklist (CBCL; parent version) was administered at baseline and annual follow-up visits (median follow-up of 3 years) to children age 6-14. Resilience was defined as consistent CBCL scores on the Internalizing, Externalizing or Total Problem T scales within normative ranges (T-scores <60) at every time point. Generalized estimating equations examined CBCL scores over time and logistic models examined demographic, socioeconomic, and cultural predictors of resilience. RESULTS:Participants included 448 children (236 PHIV, 98 PHEU, 114 HUU), with median (interquartile range) age at first evaluation of 7 (6-9) years. Children with PHIV exhibited similar rates of resilience as PHEU and HUU on the Externalizing and Total Problems scales. Resilience on the Internalizing scale was more likely in PHEU (71%) compared with PHIV (59%) or HUU (56%), P = 0.049. Factors associated with resilience in adjusted models included: HIV-exposed but uninfected status, higher household income, Cambodian nationality, female sex, and caregiver type. CONCLUSION: Despite biopsychosocial risks, resilience is observed among PHIV and PHEU children. Further study is needed to understand mechanisms underlying associated factors and intervention priorities.
Authors: Brian C Zanoni; Moherndran Archary; Tamarra Subramony; Thobekile Sibaya; Christina Psaros; Jessica E Haberer Journal: AIDS Behav Date: 2021-01